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the state of my back - a month later.

so a couple days after i wrote my last entry i got a call to schedule an appointment with pain management to get an epidural. The appointment time i was given was about two and a half weeks later, October 9th.

leading up to that i was in a manageable state of pain until the morning of friday October 5th. again, i woke up in a serious amount of pain, which wasn't too unusual since waking up is when i feel it the most, but the pain refused to go away. I had scheduled an individual appointment with one of my drum students Tori to go over some music and i didn't want to bail on her, so i drove into work hoping that the pain would eventually subside, but as i was doing that appointment with her, i ended up having to lie down to deal with the pain and try to find some relief. I was annoyed that the whole thing was interfering with my teaching, but Tori was cool about it and told me to stop apologizing about it. After i was done with that ordeal, i went in to Barry's office and told him that i was going home.

The pain was pretty intense and constant, causing me to stay home starting that friday all the way until the following friday. I spent most of those days lying down and trying not to move too much, sleeping when i could, and using some hard liquor to numb the pain when i would try to sleep which was moderately successful. I did have to write some music, which i did in spurts since sitting was uncomfortable. i think i went out maybe three times to get food supplies - i didn't eat a whole lot during that time either because the pain had been killing my appetite.

The tuesday appointment on October 9th didn't end up being an appointment for the epidural steroid injection like i thought, it was just a consultation. I was a little bent out of shape about that when i called up the hospital, but the woman assured me that once that consult was done, the epidural itself could be scheduled the same week usually, and the latest would be the following week. In the appointment on Tuesday i spent most of my time with an RN or something who did a lot of data entry to get my symptoms and other things into the system in addition to the information that was already there. He looked at the report that had come from the second MRI (which had actually said that the disc was pushing up against my L5 and not the L4 like the doctor had told me a month prior) and after doing some more stuff he said, "yeah, let's do the epidural." Then we waited for the primary pain doctor guy to come in, the time of which i filled by asking him what he was all about, which i'm prone to do when there's deadspace. We ended up chatting for a while about LSU football since that's where he got all of his schooling, as well as stuff recently going on with Tulane football.

Eventually the head pain doctor came in and did a few overview tests, said, "do you understand all of the risks involved in this procedure" to which i said yes, and five minutes later (whereas the time with the RN was close to 45 minutes) i was out the door with an epidural scheduled for thursday. So i went home and laid around for another couple of days, and then thursday morning i went to get that done.

The directions for getting to the procedure area was specifically to enter the garage, go to the fifth floor and take the fifth floor elevator. I found out later that that was because that was the only elevator that actually went to the floor that i needed to get to for some odd reason. I went to the area and saw a receptionist who had a lot of M&M paraphernalia in the form of calendars, gift baskets, and figurines that seemed to be related specifically to the hospital, like that was the way in which the pain management clinic was trying to make the atmosphere less hospital-like and more friendly and calming. I filled out some paperwork and then eventually got sent to a room.

I dealt with two RN's in the room, one was an older black guy who was pretty awesome, another older white woman who seemed like a "i put my life into very segregated black and white boxes." They ended up pushing my procedure up some because my blood pressure was unusually high, which is when i discovered in talking to them that using hard liquor to numb the pain over the past week wasn't a great idea. My blood pressure has been running higher lately anyway because i haven't been able to be terribly physically active in the past year due to the extruded disc, plus i was flipping out a little bit about the whole ordeal for some reason. They came close to saying that i needed to come back at a later date for the procedure instead since high blood pressure is problematic for this whole deal, but they tried to work it out by giving me a couple of xanax and a norvasc, and that ended up stabilizing my blood pressure to a degree that they gave the green light for the injection.

The actual procedure took five minutes max after which i was discharged pretty quickly. Mark brought me home, the drive of which i already was starting to feel better. We ended up getting some lunch, and then i went home. Some of the pain had returned, but it was too early to say if that meant anything since the pain people said that it could take 2-7 days for the long-term effect of the steroid to kick in.

The next day, friday, i was definitely feeling better than before the injection, but i was feeling worse than how i felt immediately after the injection. I took the day off with the intention of making a judgement call as to whether or not i was going to go to the evening marching band practice. Mark and i texted a bit about it in the early afternoon and the decision ended up being, "better to rest up and miss rehearsal to try to make it to the football game the next day." So i stayed home and tried to stay in a relaxed position for most of the evening and didn't really do much other than make an appointment with my PCP as a follow up to what was going on and to also take a look at what my blood pressure situation was all about.

At some point that night, i got a text from Brendan, the drumline section leader, saying, "where do you live?" it was a coin toss whether or not he was going to use it to visit me or needed it for some sort of letter of rec/application form, so i gave it to him saying, "no surprise visits allowed." About fifteen minutes later he said, "too late" and he and one of my other drum students showed up on my door with a bottle of Grey Goose vodka as a get well present. It was a very sweet gesture.

The next morning was the SMU vs Tulane football game. The pain in my leg was still in what i'd call a "medium" state - not great, but i could at least walk and sit and not feel the urge to immediately collapse even if it was somewhat painful. As the kids started filtering in for call time, the entire drumline came up to me with big smiles and a few hugs and said that they missed me. They also gave me a "get well" poster that they had all signed the day before and told me that i needed to stop being broken. It was very touching.

I made it through the game fine. Even though the pain was there, it was easily ignorable, and it got overshadowed by the fact that our football team absolutely kicked ass during the game and ended up winning 27-26 in one of the most exciting last two minutes and overall games that i've seen at Tulane since i was hired in 2008. After the game, i went home and pretty much zonked out for the night exhausted since i had only been able to get about 2 hours of sleep the night before (a regular occurrence over the past week because of how severe the pain was).

It was sunday when things turned around and i felt a significant change to how i was feeling. The pain had subsided considerably from prior to the shot and also friday/saturday to the point where i felt like i could function like a normal human being again, at least in small stretches. I had intended to take the day cleaning in preparation of Megan visiting me in town the following weekend. I didn't end up doing a lot of that - even though i was functional, i was only functional for 5-10 minute spurts at a time. Mainly i picked up all of the garbage that had been lying around for the past week while i was lying around, and i picked up various laundry that had been strewn about.

Monday i was back at work, and the pain had subsided even more. I think it flattened after that - i don't feel 100%, but i can walk now for maybe 10-15 stretches feeling nothing but a dull ache, and when the pain starts to kick in it's a minimal sort of pain that goes away as soon as i sit or lie down. It's been very manageable.

On Thursday morning (a week ago) i had an appointment with a neurologist to make sure that there wasn't any nerve damage down my leg as a result of the extruded disc, something that would help determine whether or not surgery would be the recommended route to deal with the issue long term. I showed up at that appointment and was dealt with first by an RN who said, "the first part of this test is going to make you twitch involuntarily - it freaks some people out." I smiled and said something to the effect of "i'm into new experiences," to which she laughed. The test involved her taping some wires to various parts of my leg and then prodding various parts of my leg with a two-pronged thingy. Once the pronged thing was in a spot, she would hit a button and yeah, it would make me twitch a little, but the way she described it before made me think that my whole body was going to convulse and that wasn't even close to the case. My leg would twitch slightly, i'd feel it in my head occasionally, and that was it. It wasn't pleasant, but it wasn't unpleasant either, and at some point in the middle of it, fascinated with the process, i started asking her a bunch of questions about the how and the why of what was going on. There was one part of the nerve that she was having trouble locating, but she eventually found it and told me that i was normal.

The second part of the test was done by the actual neurologist who came in not too long after the first part was done. The RN had said that there were some people that hated the second part more than the first, while others hated the first part more than the second. The second part involved the neurologist testing the actual muscles in my leg or something, something that he needed to prick me with a needle for. I don't usually have issues with that, so i thought it wouldn't be an issue.

The neurologist came in, a very friendly guy, and reiterated briefly what was going to happen with the needle. What he *didn't* tell me was that the test involved sound, something that sounded like static coming out of a speaker that would get louder or softer depending on what was going on with my muscles. He pricked me with the needle, i heard sound coming out of a speaker, he said, "could you turn it up a little" to the RN, then he asked me to flex my leg, which made the static get louder.

i immediately blurted out, "that is SO COOL." It was absolutely fascinating what was happening. Sensing the question that i didn't but was about to ask, the neurologist asked if i was an engineer, and i said, "no, but i'm a musician and i've done some stuff with sound creation," and then he explained to me what was happening. I don't remember it all, but it went something like, "the needle that i'm putting in you is concentric - it's designed to amplify and detect how much 'electrical current' is being sent to the muscle from the nervous system when you relax or tense your muscles." So he stuck the needle in a few places, had me relax or flex my leg and foot in a few different ways which caused the static to get louder or softer. It was an absolutely amazing thing to be a part of, which both the neurologist and RN commented, "i don't think we've ever had anyone think that that was cool before, not even the engineers."

The neurologist was able to tell me right away based on the readings that i got that he didn't think surgery right now was a good idea. He said that even if the surgery is the microsurgery that any surgery is invasive and weakens the spinal column slowly over time, and that i'd probably have to get surgery in my mid-late 50s again due to deterioration if i got the surgery now, and since the tests didn't indicate that i was in any danger of permanent nerve damage and i was still so young, and given how much the steroid shot i was given seemed to improve matters, that that plus similar treatments were a better solution for me. He said that could change if i started to actually lose motor function in my leg, but didn't think that was likely. I asked him if he had an opinion of long term effects of repeated steroid injections, and he said that unlike oral steroids that permeate the entire system and thus change bone structure in a negative way, concentrated steroid shots have not shown to give long-term negative side effects since the typical space between needed steroid injections to deal with the issue are infrequent enough to cause permanent change to me internally.

So he forwarded those results to the pain doctor that i had seen initially in mid-september who i have a follow-up appointment this coming thursday. In the meantime i also had the appointment with my PCP who gave me some mild blood pressure medication to take with instructions for a follow up appointment in two weeks to see where if i improve and to do some other tests such as cholesterol and other things of that sort of nature.

That's where things stand right now. I'm predicting that i might get one more injection done to try to get more healing and pain relief done, something that will hopefully retract or absorb the extruded disc to the point where it's not pushing up against my lumbar at all. Hopefully if that can fix me up well enough i can start to be physically active again and start a regular sort of exercise routine, secondly because i think it will improve my health overall, but firstly because i just feel like a damned slob and want to lose some weight and gain back some of my metabolism. We'll see what happens over the next month or so.

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( read spoken (5) — speak )
Oct. 24th, 2012 03:20 am (UTC)
All in all, it sounds pretty good. Keep going that direction.
Oct. 24th, 2012 05:58 am (UTC)
I wish you the best of luck with everything.
Oct. 24th, 2012 03:24 pm (UTC)
thanks very much sir.
Oct. 25th, 2012 11:06 am (UTC)
Brother not sir, I am not a gentleman I just act like one :D
(Deleted comment)
Oct. 24th, 2012 03:25 pm (UTC)
it wasn't bad at all. it had been bad a couple of months before, but that was less than a day tops. When i did my summer trip to eugene/estes park/chicago, the only pain i would feel would be residual pain after getting up in the morning, but walking around i never felt anything.
( read spoken (5) — speak )


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